断指再植术后血管危象预测模型的构建与研究进展

杨益, 谢广中

中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (6) : 735-740.

PDF(2076 KB)
PDF(2076 KB)
中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (6) : 735-740. DOI: 10.13418/j.issn.1001-165x.2025.6.18
综述

断指再植术后血管危象预测模型的构建与研究进展

  • 杨益1,    谢广中1,2*
作者信息 +

Prediction model construction and research progress of vascular crisis after finger replantation surgery

  • Yang Yi 1, Xie Guangzhong 1,2*
Author information +
文章历史 +

摘要

断指再植手术作为显微外科领域的重大技术突破,手术的成功与否,很大程度上取决于再植术后血管危象(vascular crisis, VC)的发生与否。血管危象是导致再植失败的主要原因。本文旨在系统综述断指再植术后血管危象预测模型的研究进展,分析其临床应用面临的挑战,并探讨基于解剖学、分子生物学和智能监测技术的多模态融合模型未来发展方向,以期提高再植成活率。

Abstract

As a major breakthrough in microsurgery, the success of digital replantation is largely determined by the occurrence of postoperative vascular crisis, which remains the primary cause of replantation failure. This article aims to provide a systematic review of the research progress in predictive models for vascular crisis following digital replantation, analyze the challenges in clinical application, and explore future directions for multimodal integration models based on anatomy, molecular biology, and intelligent monitoring technology, with the goal of improving the survival rate of replanted digits.

关键词

断指再植 /   /   / 血管危象 /   /   / 显微外科 /   /   / 预测模型 /   /   / 风险因素

Key words

  / Finger replantation /   /   / Vascular crisis /   /   / Microsurgery /   /   / Prediction model /   /   / Risk factors

引用本文

导出引用
杨益, 谢广中. 断指再植术后血管危象预测模型的构建与研究进展[J]. 中国临床解剖学杂志. 2025, 43(6): 735-740 https://doi.org/10.13418/j.issn.1001-165x.2025.6.18
Yang Yi, Xie Guangzhong. Prediction model construction and research progress of vascular crisis after finger replantation surgery[J]. Chinese Journal of Clinical Anatomy. 2025, 43(6): 735-740 https://doi.org/10.13418/j.issn.1001-165x.2025.6.18
中图分类号:      R658.1    R616.2    

参考文献

[1]  朱庆棠, 朱家恺, 劳镇国, 等. 创伤性臂丛神经损伤的早期显微外科治疗[J]. 中华显微外科杂志, 2010, 33(1): 19-22. DOI: 10.3760/cma.j.issn.1001-2036.2010.01.005.
      Zhu QT, Zhu JK, Lao ZG, et al. Early microsurgical treatment for traumatic brachial plexus injury[J]. Chin J Microsurg, 2010, 33(1): 19-22. DOI: 10.3760/cma.j.issn.1001-2036.2010.01.005.
[2]  肖思顺, 雷青, 魏平, 等. 断指再植术后发生血管危象的因素及处理[J]. 临床骨科杂志, 2017, 20(4): 447-448. DOI: 10.3969/j.issn.1008-0287.2017.04.023.
       Xiao SS, Lei Q, Wei P, et al. Factors and management of vascular crisis after digital replantation[J]. J Clin Orthop, 2017, 20(4): 447-448. DOI: 10.3969/j.issn.1008-0287.2017.04.023.
[3]  孟泽祖, 鲜航, 侯晓进, 等. 断指再植术后血管危象相关 危险因素[J]. 昆明医科大学学报, 2021, 42(1): 130-134.DOI: 10.12259/j.issn.2095-610X.S20210122.
       Meng ZZ, Xian H, Hou XJ, et al. Analysis of the risk factors associated with vascular crisis after the digits replantation[J]. Journal of Kunming Medical University, 2021, 42(1): 130-134. DOI: 10.12259/j.issn.2095-610X.S20210122.
[4]  王培吉, 董启榕, 易男, 等. 断指再植术发生血管危象的原因分析及防治措施[J]. 中华显微外科杂志, 2010, 33(1): 19-22. DOI: 10.3760/cma.j.issn.1001-2036.2010.01.009.
      Wang PJ, Dong QR, Yi N, et al. Causes and preventive measures of vascular crisis in digital replantation[J]. Chin J Microsurg, 2010, 33(1): 19-22. DOI: 10.3760/cma.j.issn.1001-2036.2010.01.009.
[5]  李艳, 王颖, 韩雪. 加强臂丛阻滞麻醉解除再植指血管危象的观察和护理[J]. 护理实践与研究, 2009, 6(10): 36-37. DOI: 10.3969/j.issn.1009-0959.2009.10.093.
      Li Y, Wang Y, Han X. Observation and nursing of enhanced brachial plexus block anesthesia for relieving vascular crisis in replanted fingers[J]. Nurs Pract Res, 2009, 6(10): 36-37. DOI: 10.3969/j.issn.1009-0959.2009.10.093.
[6]  李洪伟, 吕松峰, 李鹤, 等. 断指再植血管危象产生的原因及预防措施探讨[J]. 中国卫生产业, 2015, 12(4): 155-156. DOI: 10.16659/j.cnki.1672-5654.2015.04.075.
       Li HW, Lv SF, Li H, et al. Causes and preventive measures of vascular crisis in digital replantation[J]. China Health Ind, 2015, 12(4): 155-156. DOI: 10.16659/j.cnki.1672-5654.2015.04.075.
[7]  陈益, 王胜伟, 李文东. 断指再植后发生静脉危象患者外科治疗方法研究[J]. 中国现代医生, 2017, 55(10): 84-87.DOI:CNKI:SUN:ZDYS.0.2017-10-024.
      Chen Y, Wang SW, Li WD. Surgical treatment of venous crisis after digital replantation[J]. China Mod Dr, 2017, 55(10): 84-87.DOI: CNKI:SUN:ZDYS.0.2017-10-024.
[8]  Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review[J]. Cardiovasc Surg, 2002, 10(6): 620-630. DOI: 10.1016/S0967-2109(02)00070-4.
[9]  Zhang B, He Q, Zhou C, et al. The role of vascular endothelial cells in the pathogenesis of vascular crisis after digital replantation[J]. Microsurgery, 2021, 41(5):  479-485. DOI: https://doi.org/10.1002/micr.30738.
[10]石宇, 郑文, 赵玲珑, 等. 断指再植患者术后血清MDA、SOD、VEGF水平变化与动脉血管危象发生的关系及其预测效能[J]. 山东医药, 2023, 63(15): 11-15.  DOI: 10.3969/j.issn.1002-266X.2023.15.003.
      Shi Y, Zheng W, Zhao LL, et al. Relationship between postoperative serum MDA, SOD, VEGF levels and arterial vascular crisis in digital replantation patients and their predictive efficacy[J]. Shandong Med J, 2023, 63(15): 11-15.  DOI: 10.3969/j.issn.1002-266X.2023.15.003.
[11] 谢传信. 断指再植术后血管危象的危险因素探讨及预防对策:110例回顾性研究[J]. 临床医学研究与实践, 2024, 9(17): 25-28. DOI: 10.19347/j.cnki.2096-1413.202417007.
      Xie CX. Risk factors and preventive strategies for vascular crisis after digital replantation: a retrospective study of 110 cases[J]. Clin Res Pract, 2024, 9(17): 25-28. DOI: 10.19347/j.cnki.2096-1413.202417007.
[12] 李显勇, 李平华, 李章超. 手指撕脱伤断指再植术后血管危象发生的危险因素分析[J]. 实用手外科杂志, 2020, 34(2): 194-197. DOI: 10.3969/j.issn.1671-2722.2020.02.024.
      Li XY, Li PH, Li ZC. Risk factors for vascular crisis after digital replantation for finger avulsion injury[J]. J Pract Hand Surg, 2020, 34(2): 194-197. DOI: 10.3969/j.issn.1671-2722.2020.02.024.
[13] 石荣光, 李冬梅, 王琳, 等. 断指再植术后血管危象与环境因素相关性分析[J]. 华北煤炭医学院学报, 2009, 11(1): 31-32. DOI:CNKI:SUN:MTYX.0.2009-01-022.
       Shi RG, Li DM, Wang L, et al. Correlation between vascular crisis after digital replantation and environmental factors[J]. J North China Coal Med Coll, 2009, 11(1): 31-32. DOI: CNKI:SUN:MTYX.0.2009-01-022.
[14] 李炜伟, 覃小荣, 唐小芳, 等. 股前外侧穿支皮瓣修复口腔颌面部肿瘤术后缺损发生血管危象的相关因素分析[J]. 中国美容医学, 2023, 32(5): 162-166. DOI: 10.15909/j.cnki.cn61-1347/r.005688.
      Li WW, Qin XR, Tang XF, et al. Related factors of vascular crisis in anterolateral thigh perforator flap for reconstruction of oral and maxillofacial defects after tumor surgery[J]. Chin J Aesthetic Med, 2023, 32(5): 162-166. DOI: 10.15909/j.cnki.cn61-1347/r.005688.
[15] 石荣华, 赵云富, 刘渊, 等. 浅静脉及深浅静脉回流对183例前臂皮瓣存活率的影响[J]. 口腔颌面外科杂志, 2012, 22(4): 252-256. DOI: 10.3969/j.issn.1005-4979.2012.04.006.
      Shi RH, Zhao YF, Liu Y, et al. Effect of superficial and deep venous return on survival rate of 183 forearm flaps[J]. J Oral Maxillofac Surg, 2012, 22(4): 252-256. DOI: 10.3969/j.issn.1005-4979.2012.04.006.
[16] 毛雷音, 周文, 莫兰, 等. 基于德尔菲法构建断指再植患者围手术期血管危象风险评估量表[J]. 江苏卫生事业管理, 2024, 34(3): 372-376. DOI: 10.3969/j.issn.1005-7803.2024.03.018.
       Mao LY, Zhou W, Mo L, et al. Development of a perioperative vascular crisis risk assessment scale for digital replantation patients based on Delphi method[J]. Jiangsu Health Syst Manag, 2024, 34(3): 372-376. DOI: 10.3969/j.issn.1005-7803.2024.03.018.
[17] 杨灿, 李琦, 刘炎, 等. 机器学习饮食质量评分与心血管疾病风险[J]. 中国科学技术大学学报, 2023, 53(12): 1302-1310. DOI: 10.52396/JUSTC-2023-0067.
       Yang C, Li Q, Liu Y, et al. Machine learning-based dietary quality score and cardiovascular disease risk[J]. J Univ Sci Technol China, 2023, 53(12): 1302-1310. DOI: 10.52396/JUSTC-2023-0067.
[18] 李彩福, 赵伟, 叶秀春, 等. 基于机器学习算法的社区老年衰弱前期风险预测模型构建[J]. 护理学杂志, 2022, 37(15): 84-88. DOI: 10.3870/j.issn.1001-4152.2022.15.084.
       Li CF, Zhao W, Ye XC, et al. Construction of a risk prediction model for pre-frailty in community-dwelling elderly based on machine learning algorithm[J]. J Nurs Sci, 2022, 37(15): 84-88. DOI: 10.3870/j.issn.1001-4152.2022.15.084.
[19] Lou LB, Xu L, Wang XF, et al. Comprehensive assessment of risk factors and development of novel predictive tools for perioperative hidden blood loss in intertrochanteric femoral fractures: a multivariate retrospective analysis[J]. J Orthop Surg Res, 2024, 19(1): 198. DOI: 10.1186/s13018-024-04631-0.
[20] 李慧娟, 刘艳, 刘英, 等. 影响断指再植术后血管危象发生的高危因素分析及风险预测模型构建[J]. 临床外科杂志, 2024, 32(12): 1255-1258. DOI: 10.3969/j.issn.1005-6483.2023.16.042.
       Li HJ, Liu Y, Liu Y, et al. Analysis of high-risk factors affecting vascular crisis after digital replantation and construction of a risk prediction model[J]. J Clin Surg, 2024, 32(12): 1255-1258. DOI: 10.3969/j.issn.1005-6483.2023.16.042.
[21]吴广飞, 王星, 范冬梅, 等. 2型糖尿病足截肢危险因素及血脂综合指数对下肢动脉钙化的预测效能[J]. 血管与腔内血管外科杂志, 2022, 8(6): 758-763. DOI: 10.19418/j.cnki.issn2096-0646.2022.06.24.
      Wu GF, Wang X, Fan DM, et al. Risk factors for amputation in type 2 diabetic foot and predictive efficacy of lipid composite index for lower extremity arterial calcification[J]. J Vasc Endovasc Surg, 2022, 8(6): 758-763. DOI: 10.19418/j.cnki.issn2096-0646.2022.06.24.
[22]于永翔, 张明, 陈晓伟, 等. 基于区域健康信息平台的2型糖尿病患者糖尿病足发病风险预测模型构建及应用[J]. 中华流行病学杂志, 2024, 45(7):997-1006. DOI:10.3760/cma.j.cn112338-20231218-00360.
      Yu YX, Zhang M, Chen XW, et al. Construction and application of a risk prediction model for diabetic foot in type 2 diabetes patients based on regional health information platform[J]. Chin J Epidemiol, 2024, 45(7): 997-1006. DOI:10.3760/cma.j.cn112338-20231218-00360.
[23]Dong ZJ, Hou RH, Jiang H, et al. Mixed thermoelectric-triboelectric smart knitted fabric for real-time monitoring of vascular crisis and rehabilitation after digital replantation[J]. Mater Des, 2025, 251: 113669. DOI: 10.1016/j.matdes.2025.113669.
[24] 王俊峰, 章仲恒, 周支瑞, 等. 临床预测模型:模型的验证[J]. 中国循证心血管医学杂志, 2019, 11(2): 141-144. DOI: 10.3969/j.issn.1674-4055.2019.02.04 
      Wang JF, Zhang ZH, Zhou ZR, et al. Clinical prediction models: model validation[J]. Chin J Evid Based Cardiovasc Med, 2019, 11(2): 141-144. DOI: 10.3969/j.issn.1674-4055.2019.02.04
[25] 王钰, 马玉芬, 邓海波, 等. 国内静脉血栓栓塞症护理研究热点的共词聚类分析[J]. 中华护理杂志, 2020, 55(7): 1001-1005. DOI: 10.3761/j.issn.0254-1769.2020.07.007.
      Wang Y, Ma YF, Deng HB, et al. Co-word clustering analysis of research hotspots in venous thromboembolism nursing in China[J]. Chin J Nurs, 2020, 55(7): 1001-1005.DOI: 10.3761/j.issn.0254-1769.2020.07.007.
[26] 肖思顺, 雷青, 魏平. 断指再植术后发生血管危象的因素及处理[J]. 临床骨科杂志, 2017, 20(4): 447-448. DOI: 10.3969/j.issn.1008-0287.2017.04.023.
       Xiao SS, Lei Q, Wei P. Factors and management of vascular crisis after digital replantation[J]. J Clin Orthop, 2017, 20(4): 447-448. DOI: 10.3969/j.issn.1008-0287.2017.04.023.
[27] 何旭, 侯书健, 赵靖, 等. 断指再植术后血管危象的多因素分析[J]. 中华手外科杂志, 2007, 23(1): 12-15. DOI: 10.3760/cma.j.issn.1005-054X.2007.01.004.
       He X, Hou SJ, Zhao J, et al. Multivariate analysis of vascular crisis after digital replantation[J]. Chin J Hand Surg, 2007, 23(1): 12-15. DOI: 10.3760/cma.j.issn.1005-054X.2007.01.004.
[28] 黄飞, 陈日恒, 罗耀辉, 等. 手指撕脱伤患者断指再植术后发生血管危象的相关因素[J]. 中外医学研究, 2021, 19(11): 50-52. DOI: 10.3969/j.issn.1674-6805.2021.11.020.
      Huang F, Chen RH, Luo YH, et al. Related factors of vascular crisis after digital replantation in patients with finger avulsion injury[J]. Chin Foreign Med Res, 2021, 19(11): 50-52. DOI: 10.3969/j.issn.1674-6805.2021.11.020.
[29] 阳富春, 赵劲民, 杨志, 等. 断指再植迟发性血管危象的原因探讨及其预防[J]. 中华显微外科杂志, 2005, 29(4): 305-306.
      Yang FC, Zhao JM, Yang Z, et al. Causes and prevention of delayed vascular crisis after digital replantation [J]. Chin J Microsurg, 2005, 29(4): 305-306.
[30] 张继朝, 郑大伟, 魏英华, 等. 断指再植术后4周血管危象1例报告及文献复习[J]. 创伤外科杂志,2020, 22(2):156-157. DOI: 10.3969/j.issn.1009-4237.2020.02.019.
       Zhang JC, Zheng DW, Wei YH, et al. Vascular crisis 4 weeks after digital replantation: a case report and literature review [J]. J Trauma Surg,2020, 22(2): 156-157. DOI: 10.3969/j.issn.1009-4237.2020.02. 019.

PDF(2076 KB)

Accesses

Citation

Detail

段落导航
相关文章

/